Research: The risk of infection remains an important cause of morbidity and mortality in patients with chronic inflammatory skin diseases; however, baseline rates of infection, which may be altered due disease-associated immune defects, impaired epidermal barrier function, other co-morbid diseases and behaviors, use of immune suppressive treatment and suboptimal utilization of vaccines, are generally poorly defined. Specifically, respiratory infections are relatively common causes of morbidity and mortality, and adherence with immunization strategies against viral and bacterial causes of pneumonia in patients with chronic inflammatory skin disease are not well understood. The purpose of this study is to: 1.Determine the risk of hospitalization and evaluate risk factors for pneumonia in patients with chronic inflammatory skin diseases 2.Compare the rate of influenza and pneumonia vaccination among patients with chronic skin diseases to the vaccination rate in the general population and identify predictors of vaccination 3.Determine beliefs regarding and perceived barriers to vaccination in adults with chronic skin diseases. The overall objectives of this proposal are to improve the care of patients with chronic inflammatory skin diseases by identifying patients with chronic skin diseases at highest risk for serious pneumonia and opportunities for prevention. Candidate: Megan Noe, M.D., MPH graduated from Tufts University School of Medicine in 2011. In 2015, she became a board certified dermatologist after completing her dermatology residency at the University of Iowa. She is currently an Instructor and Postdoctoral Fellow at the University of Pennsylvania, pursuing additional training in clinical epidemiology. Dr. Noe?s long-term goal is to become a R01-funded independent investigator focused decreasing infectious complications of chronic inflammatory skin diseases. Environment: During the award period Dr. Noe will devote 80% of her time to clinical research and 20% to the clinical care of patients with chronic inflammatory skin disease like psoriasis. Dr. Gelfand, the candidate?s primary mentor, has directly supervised the training of numerous successful junior faculty members and Dr. Noe will benefit from his experience and enthusiasm for cultivating the careers of junior scientists. The rich training environment and expertise available in Dr. Gelfand?s laboratory and at the University of Pennsylvania, both in the Dermatology Department and in the Center for Clinical Epidemiology and Biostatistics, combine to provide an unparalleled opportunity to begin a career as a physician scientist. Career Development: With the support of her advisory committee, her training will focus on: administrative claims data analysis, qualitative research methods and infectious disease epidemiology methods. Completion of the proposed research and career development plan will give Dr. Noe the knowledge and skills necessary to achieve scientific independence, transition to a tenure- track faculty position and build a strong foundation for a career in patient oriented clinical research.